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Comparison between the Staphylococci aureus and coagulase-negative staphylococci infected total joint arthroplasty

Zhisen Gao1, Yinqiao Du1, Shang Piao1

  • 1The General Hospital of Chinese People's Liberation Army, No.28 of Fuxing Road, Haidian District, Beijing, 100853, China.

Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association
|September 6, 2018
PubMed
Abstract

Insights

Staphylococcus aureus (SA) peri-prosthetic joint infection (PJI) presents with higher ESR and sinus tracts than coagulase-negative staphylococci (CoNS) PJI. Both SA and CoNS PJI show similar high infection control rates with two-stage revision.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Microbiology

Background:

  • Staphylococcus species are primary causes of peri-prosthetic joint infection (PJI).
  • Coagulase-positive staphylococci (SA) and coagulase-negative staphylococci (CoNS) exhibit differing virulence.
  • Limited comparative data exists on clinical PJI manifestations and treatment outcomes between SA and CoNS.

Purpose of the Study:

  • To compare clinical presentations and two-stage revision outcomes for PJI caused by SA versus CoNS.
  • To identify risk factors influencing treatment success in PJI patients undergoing revision surgery.

Main Methods:

  • Retrospective analysis of 260 patients with PJI undergoing two-stage revision surgery (January 2003 - June 2015).
  • Patients were categorized into SA (n=23) and CoNS (n=64) infection groups.
  • Clinical data, including ESR, sinus tract presence, and treatment outcomes, were analyzed.

Main Results:

  • SA PJI group showed significantly higher preoperative ESR (median 60.9 vs 35.9) and more frequent sinus tract occurrence (73.9% vs 18.8%) compared to CoNS PJI.
  • Overall infection control rates were high and comparable: 90.6% for CoNS and 87.0% for SA.
  • Previous surgical history emerged as a significant risk factor for treatment failure (OR=6.2) after adjusting for covariates.

Conclusions:

  • SA PJI is associated with elevated ESR and a higher incidence of sinus tracts compared to CoNS PJI.
  • Two-stage revision achieves comparable high infection control rates (around 90%) for both SA and CoNS PJI.
  • Prior surgical history is a potential predictor of poorer outcomes in PJI patients undergoing two-stage revision.

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